To establish physical activity level, environment and social interaction in routine stroke rehabilitation practice.
Prospective observational study using behavioural mapping.
Patients at 4 hospital ...stroke rehabilitation units in Sweden at least 7 days post-stroke were observed over 1 week-day at 10 min intervals between 08.00 h and 17.00 h. At each observation, physical activity, location and people present were ascertained.
Patients (n = 104) had a mean age of 70.3 (standard deviation (SD) 14.4) years. Median time since stroke was 19 (range 7-142) days. Patients were alone for 52% of the day, during this time 7% was spent in standing/walking activities. While with a physiotherapist patients were standing/walking for 43% of the time. Using median regression it was found that the median percentage of time spent in standing/walking was associated with gait independence and age. Gait independence increased the median percentage of time spent in standing/walking by 16.5% (95% confidence interval (CI) 12.1-20.9, p < 0.001), while an increase of 1 year of age reduced the median percentage of time spent in standing/walking by 0.16% (95% CI -0.31 to -0.01, p < 0.05).
Patients had low levels of physical activity and social interaction. This study suggests that there is a huge potential to increase patients' activity level and augment social interaction above current levels.
Lyme disease, human granulocytic anaplasmosis (HGA), and babesiosis are emerging tick-borne infections.
To provide an update on diagnosis, treatment, and prevention of tick-borne infections.
Search ...of PubMed and Scopus for articles on diagnosis, treatment, and prevention of tick-borne infections published in English from January 2005 through December 2015.
The search yielded 3550 articles for diagnosis and treatment and 752 articles for prevention. Of these articles, 361 were reviewed in depth. Evidence supports the use of US Food and Drug Administration-approved serologic tests, such as an enzyme immunoassay (EIA), followed by Western blot testing, to diagnose extracutaneous manifestations of Lyme disease. Microscopy and polymerase chain reaction assay of blood specimens are used to diagnose active HGA and babesiosis. The efficacy of oral doxycycline, amoxicillin, and cefuroxime axetil for treating Lyme disease has been established in multiple trials. Ceftriaxone is recommended when parenteral antibiotic therapy is recommended. Multiple trials have shown efficacy for a 10-day course of oral doxycycline for treatment of erythema migrans and for a 14-day course for treatment of early neurologic Lyme disease in ambulatory patients. Evidence indicates that a 10-day course of oral doxycycline is effective for HGA and that a 7- to 10-day course of azithromycin plus atovaquone is effective for mild babesiosis. Based on multiple case reports, a 7- to 10-day course of clindamycin plus quinine is often used to treat severe babesiosis. A recent study supports a minimum of 6 weeks of antibiotics for highly immunocompromised patients with babesiosis, with no parasites detected on blood smear for at least the final 2 weeks of treatment.
Evidence is evolving regarding the diagnosis, treatment, and prevention of Lyme disease, HGA, and babesiosis. Recent evidence supports treating patients with erythema migrans for no longer than 10 days when doxycycline is used and prescription of a 14-day course of oral doxycycline for early neurologic Lyme disease in ambulatory patients. The duration of antimicrobial therapy for babesiosis in severely immunocompromised patients should be extended to 6 weeks or longer.
In little more than 30 years, Lyme disease, which is caused by the spirochaete Borrelia burgdorferi, has risen from relative obscurity to become a global public health problem and a prototype of an ...emerging infection. During this period, there has been an extraordinary accumulation of knowledge on the phylogenetic diversity, molecular biology, genetics and host interactions of B. burgdorferi. In this Review, we integrate this large body of information into a cohesive picture of the molecular and cellular events that transpire as Lyme disease spirochaetes transit between their arthropod and vertebrate hosts during the enzootic cycle.
The Lyme disease bacterial pathogen, Borrelia burgdorferi, establishes a long-term infection inside its mammalian hosts. Despite the continued presence of the bacteria in animal models of disease, ...inflammation is transitory and resolves spontaneously. T cells with limited effector functions and the inability to become activated by antigen, termed exhausted T cells, are present in many long-term infections. These exhausted T cells mediate a balance between pathogen clearance and preventing tissue damage resulting from excess inflammation. Exhausted T cells express a variety of immunoinhibitory molecules, including the molecule PD-1. Following B. burgdorferi infection, we found that PD-1 and its ligand PD-L1 are significantly upregulated on CD4+ T cells and antigen presenting cell subsets, respectively. Using mice deficient in PD-1, we found that the PD-1/PD-L1 pathway did not impact bacterial clearance but did impact T cell expansion and accumulation in the ankle joint and popliteal lymph nodes without affecting B cell populations or antibody production, suggesting that the PD-1/PD-L1 pathway may play a role in shaping the T cell populations present in affected tissues.
Lyme Disease Hu, Linden T
Annals of internal medicine,
2016-May-03, Letnik:
164, Številka:
9
Journal Article
Recenzirano
This issue provides a clinical overview of Lyme disease, focusing on prevention, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information ...and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.
Background
Tick‐borne encephalitis (TBE), caused by the TBE virus (TBEV), is a major neurotropic infection throughout Europe and Asia, with a considerable risk of neurological sequelae. Our aim was ...to study the symptoms in patients with TBE in Western Gotaland between 1997 and 2012 in the acute phase and at follow‐up after 2–15 years (median: 5.5 years).
Methods
The medical records of 96 patients with TBE were studied. Phone‐based interviews were held with 92 patients and 58 controls, matched by age, gender and residential area. The Encephalitis Support Group Questionnaire (ESGQ) 2000 was used, further developed with dimensions and scoring 1–4, where a high score is related to better outcome. Patients and controls also answered a written survey regarding functional outcome of sleep (FOSQ).
Results
Of the patients, 35% had a mild disease, 56% moderate and 7.3% severe disease. At the follow‐up, patients scored significantly lower than controls in the dimensions of memory/learning, executive functions, vigilance and physical impairments. In addition, the answers concerning tiredness/fatigue, poor concentration/attention, reduced initiative/motivation, balance disturbances, coordination problems, difficulties with short‐ and long‐term memory, learning difficulties and problems with fine motor skills resulted in significantly lower scores in the patients compared with the controls. The patients scored lower than the controls in the FOSQ dimension social outcome.
Conclusions
At the long‐term follow‐up, the patients scored significantly lower in a diversity of neurocognitive and motor symptoms, in comparison with controls. These sequelae and their pathogenesis should be further explored and specific neurocognitive assessment tests are needed.
, the causative agent of Lyme disease, is transmitted by the bite of an infected tick. Once inoculated into the host dermis, it disseminates to various organs including distant skin sites, the heart, ...the joint and the nervous system. Most humans will develop an early skin manifestation called erythema migrans at the tick bite site. This can be followed by symptoms such as carditis, neuritis, meningitis, or arthritis if not treated. A specific mouse strain, C3H/HeN develops arthritis with
infection whereas another strain, C57BL/6, develops minimal to no arthritis. Neither strain of mice show any skin signs of rash or inflammation. Factors that determine the presence of skin inflammation and the joint arthritis susceptibility in the host are only partially characterized. We show in this study that murine fibroblast-like synoviocytes display trained immunity, a program in some cells that results in increased inflammatory responses if the cell has previously come in contact with a stimulus, and that trained immunity in fibroblast-like synoviocytes tested ex vivo correlates with Lyme arthritis susceptibility. Conversely, skin fibroblasts do not exhibit trained immunity, which correlates with the absence of skin symptoms in these mice. Moreover, we demonstrate that the trained phenotype in FLS is affected by the cell environment, which depends on the host genetic background. Future studies expanding this initial report of the role of trained immunity on symptoms of
infection may provide insight into the pathogenesis of disease in murine models.
We present an analysis of , O iii88, N ii122, and far-infrared (FIR) fine-structure line observations obtained with Herschel/PACS, for ∼240 local luminous infrared galaxies (LIRGs) in the Great ...Observatories All-sky LIRG Survey. We find pronounced declines ("deficits") of line-to-FIR continuum emission for N ii122, , and as a function of FIR color and infrared luminosity surface density, . The median electron density of the ionized gas in LIRGs, based on the N ii122/N ii205 ratio, is = 41 cm−3. We find that the dispersion in the deficit of LIRGs is attributed to a varying fractional contribution of photodissociation regions (PDRs) to the observed emission, f( ) = / , which increases from ∼60% to ∼95% in the warmest LIRGs. The / ratio is tightly correlated with the PDR gas kinetic temperature in sources where is not optically thick or self-absorbed. For each galaxy, we derive the average PDR hydrogen density, , and intensity of the interstellar radiation field, G, in units of and find G/ ratios of ∼0.1-50 cm3, with ULIRGs populating the upper end of the distribution. There is a relation between G/ and , showing a critical break at 5 × 1010 L kpc−2. Below , G/ remains constant, 0.32 cm3, and variations in are driven by the number density of star-forming regions within a galaxy, with no change in their PDR properties. Above , G/ increases rapidly with , signaling a departure from the typical PDR conditions found in normal star-forming galaxies toward more intense/harder radiation fields and compact geometries typical of starbursting sources.
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